Provider Demographics
NPI:1104604479
Name:REEDUS, BRITTANY MONIQUE
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MONIQUE
Last Name:REEDUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14218 CALLE CONTESA
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-5490
Mailing Address - Country:US
Mailing Address - Phone:760-221-6530
Mailing Address - Fax:760-221-6530
Practice Address - Street 1:211 S PRIMROSE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2856
Practice Address - Country:US
Practice Address - Phone:626-359-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist